Pediatric Intussusception

00:01 Our topic now goes into pediatric intussusception.

00:05 How did this take place? Well, intussusception here, maybe perhaps there is a vasculitis taking place of the intestines such as Henoch-Schönlein purpura.

00:16 Maybe there is that Meckel's diverticulum or maybe in general, you just had folding of one intestine to the other.

00:24 Folding.

00:25 There’s something called intussuscipien, intussusceptum.

00:27 That’s a little bit too much detail.

00:29 The point is that the – there’s telescoping.

00:32 Think about telescope. What do you do with a telescope? You pull it out.

00:35 When you want to see something and you put it back in.

00:39 Well, that’s what’s happening with intussusception.

00:41 One area of the intestine is folding into another.

00:45 Literally, telescoping.

00:47 This is not good.

00:49 The child is going to then have bilious vomiting.

00:52 The child may then be passing blood through the stool.

00:56 You might have heard of something called currant jelly stool.

00:59 It looks so incredibly appetizing.

01:02 I’m sorry that I’m being a little sick here, but whatever.

01:04 It does, it looks like currant jelly.

01:06 Amazing! There’s blood in the stool.

01:09 In addition, When you feel the abdomen, but this time, you have a folding.

01:15 This is not an olive.

01:17 An olive means what? Pyloric stenosis.

01:20 So what is this? You’re feeling a sausage and I’ll show you a picture upcoming.

01:25 Let’s talk about intussusception.

01:27 A portion of the GI tract telescoping into the portion distal to it.

01:32 Early: six to two years of age.

01:35 In fact, as rule of thumb in practice, you have an infant or a child between two months to two years with obstruction and colic.

01:49 At this point, with that type of history, you are being very aggressive in terms of investigating intussusception.

01:56 It is associated with lymphoid hyperplasia, Peyer’s patches, Meckel’s diverticulum or perhaps even rotavirus vaccine.

02:07 Signs and symptoms would be the following.

02:09 Acute onset, cramping, intermittent pain to the point where the child and the infant is crying, lethargy.

02:17 What does currant jelly stool mean to you? It’s dark.

02:20 Why? There’s passage of blood with the stool.

02:24 And upon examination, sausage-shaped mass.

02:30 I’ll show a picture where you’ll never forget it.

02:32 Diagnosis: Clinical history is sufficient for intervention.

02:36 By clinical history, we mean there’s quite a bit of colic and pain between the ages of two months and two years.

02:42 Ultrasound, plain films are supportive.

02:46 And air enema is diagnostic and therapeutic.

02:50 That’s what you’re paying attention to.

02:52 Literally, remember, this is causing what kind of obstruction? Mechanical obstruction.

02:57 So therefore, barium enema is actually going to then cause, well, increasing diameter of the intestine.

03:04 And very much, it’s going to relieve the child’s discomfort, diagnostic and therapeutic.

03:11 You definitely want to know those tests, which then provide both those types of experiences or those type of luxuries.

03:24 Enema reduction successful in 50% of your cases, in fact apart from it being diagnostic.

03:30 And take a look at this please.

03:32 Let me walk you through this.

03:33 On the left end, you find that there’s a little bit of -- it’s a smaller end, meaning to say that that was a normal intestine.

03:43 It folded into the distal portion.

03:46 And that red, beefy type of intestine that you’re seeing there, If you were feel that in the abdomen, it would feel like what? A sausage.

03:57 With such pictures, I believe that there’s absolutely no way that you are going to miss such questions.

04:03 Sausage shape.

04:05 Currant jelly.

04:06 The child being quite discomfort.

04:08 Welcome to intussusception.